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World J Psychiatr. Sep 22, 2017; 7(3): 148-158
Published online Sep 22, 2017. doi: 10.5498/wjp.v7.i3.148
Tattoos as a window to the psyche: How talking about skin art can inform psychiatric practice
Hannah Roggenkamp, Andrew Nicholls, Joseph M Pierre
Hannah Roggenkamp, Mental Illness Research, Education and Clinical Center, VA Puget Sound Healthcare System, Seattle, WA 98108, United States
Andrew Nicholls, Joseph M Pierre, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, United States
Joseph M Pierre, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, United States
Author contributions: All authors equally contributed to this paper with regard to conception and determination of scope, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Joseph M Pierre, MD, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Building 210 Room 15, Los Angeles, CA 90073, United States. joseph.pierre2@va.gov
Telephone: +1-310-4783711 Fax: +1-310-2684448
Received: February 8, 2017
Peer-review started: February 12, 2017
First decision: May 10, 2017
Revised: May 18, 2017
Accepted: July 7, 2017
Article in press: July 9, 2017
Published online: September 22, 2017
Abstract

Tattooing the skin as a means of personal expression is a ritualized practice that has been around for centuries across many different cultures. Accordingly, the symbolic meaning of tattoos has evolved over time and is highly individualized, from both the internal perspective of the wearer and the external perspective of an observer. Within modern Western societies through the 1970s, tattoos represented a cultural taboo, typically associated with those outside of the mainstream such as soldiers, incarcerated criminals, gang members, and others belonging to marginalized and counter-cultural groups. This paper aims to review the more recent epidemiology of tattoos in Western culture in order to establish that tattooing has become a mainstream phenomenon. We then review psychological and psychiatric aspects of tattoos, with a goal of revising outmoded stigmas about tattooing and helping clinicians working with tattooed patients to facilitate an exploration of the personal meaning of skin art and self-identity. We suggest that as a kind of augmentation of the physical exam, looking at and talking to patients about their tattoos can provide a valuable window into the psyche, informing clinical practice.

Keywords: Tattoos, Military psychiatry, Deviance, Skin art, Psychopathology, Psychology

Core tip: Although traditionally associated with deviance and psychopathology in modern Western culture, tattoos have evolved into a mainstream phenomenon, especially among younger adults. While there are myriad motivations for obtaining a tattoo, most individuals seek tattoos as a means of personal expression that provides a potential window into the psyche that can be used to facilitate psychiatric treatment. By reviewing the literature on psychological and psychiatric aspects of tattooing, we suggest that tattoos should be viewed not as signs of pathology, but as opportunities to explore core aspects of self-identity that can be valuable in clinical work.